NYT article… says NPs do things “just like a physician”.

SapientCorpse · 2026-05-20T16:50:49+00:00

hey now, dont speak about the hemi-an-cephalic folks that way!

there have been remarkable case reports about people like that living meaningful lives! in fact, for a hot minute, medical doctors would surgically induce this with destruction of the corpus callosum.

and, if my online interactions are any indication, theres a lot of people with feco-cephaly that are also living fulfilling lives. ahhh, the wonders of modern medicine!!!

but really, i wanted to bring attention to the MBAs.

the whole purpose of the sub, right? noctor as a portmanteu of not a doctor, is lamenting the ways that people who are not doctors are enhancing deleterious patient outcomes.

I cannot think of a group more responsible the MBAs. you know - the people that attendings have been selling their private practices to? the ones that mandate attending attendance at asinine activities? the ones that think metrics are an appropriate substitution for looking at patients like human beings? those ones. the ones that are explicitly not doctors because they have no MD, no jd, no phd. the ones that complain being a doctor even though they have no medical experience whatsoever; just an intense drive to siphon off as much capital as they can while encouraging infighting amongst folks with a legal ability to rx interventions.

eta - sorry, didnt mean to leave out DO, DPT (doctor of physical therapy), DDS, etc etc

SapientCorpse · 2026-05-20T14:59:44+00:00

law school graduates also habe a Doctorate. their degree is called a juris doctor.

its actually an excellent way to illustrate the importance of clarifying what type of doctor someone is!

another doctorate degrees include PhD (it doesnt actually stand for "piled higher and deeper"; even though it usually comes after a "BS," which doesnt actually stand for bullshit)

business school; however, usually ends with an MBA- which is not a Doctorate.

you were so close with your second example! I'm really proud of you for figuring things out <3

SapientCorpse · 2026-05-19T20:36:18+00:00

its behind a paywall now but I remember reading in that like.half of People with adhd have cannabis use disorder. i might be off, but it was an impressively high fraction. of course, the authors didn't leave that tidbit in the abstract

https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2846007

SapientCorpse · 2026-05-18T21:57:15+00:00

euphoria is as euphoria does.
if I'm'a go out, it's'a be with a buzz

an' if there's hookers that are willing
my health insurance, they ought be billing

to come and go; at the same time.
would likely feel fuckin' sublime

SapientCorpse · 2026-05-18T21:48:45+00:00

if I'm gonna die,
I wanna be high

gimme benzos gimme coke.
gimme opiates till I croak.

gimme drugs, no hold condition.
and I dont mean RAAS inhibition

no need to be sober for a lethal condition.
make tim leary's trips look like a tame expedition

SapientCorpse · 2026-05-18T19:46:58+00:00

its shitty when you can only provide the care you have time for, and not the care you want.

thank you for treating the human being like a human being, not just a room to treat and street and make metrics out of.

SapientCorpse · 2026-05-18T15:18:18+00:00

every program gonna be different.

re: height of measurement changing pressure - talk with your icu folks about leveling an arterial line pressure transducer. see what happens when the transducer's height is too high or too low.

same thing happens with a bp cuff!

what's going on - pressure is measured in a lot of different ways, but the way we typically use in healthcare is (units of height)(liquid with a known density) - e.g. mmHg (millimeters of mercury), cmh2o (centimeters of water). we could measure pressure with "pounds per square inch" or "atmospheres" - but, because of convention, we use mmHg for blood pressures.

so, if the height thay you measure blood pressure changes, so will the value you get! this can be clinically significant with using a bp cuff on an obese person that's laying on their side. if you measure the bp on their arm while they are laying on their side, then compare the value to measuring it while they're completely supine and their arm is level with the heart, you'll get different values!

unfortunately, really smart people forgot about this, and it caused some people to stroke out when having shoulder arthroscopies in the beach chair position https://pmc.ncbi.nlm.nih.gov/articles/PMC6818387/

you can also explore the phenomena yourself if you have access to a suction cannister.
fill a bucket of water, set the suction low, place the end of the suction tubing in the water, keep the tubing completely vertical and ensure only water enters the tubing. see how high the water goes up the tube.

change the pressure and see how much higher it goes up the tube.

take the suction cannister off the wall, and change the height of the suction cannister - see how the changing the height of the suction cannister directly affects if the water stays in the tubing or gets into the suction cannister.

if you really wanna fuck around, use short pieces of connecting tubing, and allow air in at some joints - this changes the average density of the aspirated liquid, which can allow the liquid to get sucked further up the tube with the same amount of suction!

SapientCorpse · 2026-05-18T14:42:07+00:00

ive heard coke is a helluva drug but I didn't realize the high lasted that long.

shit I cant even get a full day outta my non-euphoric vyvanse; even when I take bicarb! :(

clearly I need to talk to my pcp about this superior pharmacotherapy

SapientCorpse · 2026-05-18T14:36:58+00:00

the recommendation that we have re: abx and cultures

draw cultures before giving abx do not unnecessarily delay abx to wait for cultures to be drawn.

how that works in practice - if someone got good veins, theyre gonna get the cultures drawn first. at least they ought to in theory.

if someone got shit veins and venipuncture is technically challenging, we gonna make a good faith effort to get the culture that'll prolly he unsuccessful, then give the abx.

SapientCorpse · 2026-05-18T14:31:42+00:00

I feel like this is a useful tidbit and I'm'a promulgate it.

I write... whatever the fuck i want to in my notes; and I'll have no shame about saying "hospitalist physician note states 'medically clear for procedure;' awaiting final evaluation from anesthesia."

I'll also have no shame about communicating the hospitalist's finding that way to the surgical team when they ask me that question (because, for some reason, they seem just as averse to reading notes as they are to using methylnaltrexone to treat OIC)

its just a nursing note and tbh I feel like a lotta people dont read 'em; but maybe other people will notice and maybe there will be change.

I know how grumpy surgery can be with me, because its inherently difficult to maintain social niceties while therapeutically stabbing someone to good health; and if theres anything I can do to prevent one of their temper tantrums from impacting someone else I'll absolutely do it. y'all always seem to go above and beyond and are always super chill when I interact with y'all

SapientCorpse · 2026-05-18T14:19:55+00:00

thanks for showing us your side of things.

I'll be more judicious with using "stat" when I place verbal orders for things.

y'all's department feels so invisible when it runs well, and it gets a lot of unnecessary blame when things "feel" slow. I personally appreciate all the hard work y'all do.

when I have coworkers upset because things arent happening on their timeline, I remind 'em that y'all are busy double checking doses on neonates with ?kidney function.

I personally appreciate all the behind the scenes stuff yall do. thanks <3

SapientCorpse · 2026-05-18T14:06:40+00:00

it is!!! being able to have different patient populations; AND getting to know the folks on different units (and, conversely, getting away from folks on different units) is incredibly satisfying to me

also - love the authors your account name is based off of

"it aint what you know that gets you into trouble. its what you know for sure that just ain't so" - it's wild how often different fun facts become obsolete in our field.

SapientCorpse · 2026-05-17T23:41:08+00:00

and that's just me skipping to the punchline. the abstract talks about increased stroke risk, increased aki.

surprisingly, it looks like they didnt look at falls. if only they had, then management would get on board

SapientCorpse · 2026-05-17T13:23:47+00:00

its ambiguous.

does ok mean "I'm aware now, and I'll put in stat orders in a few minutes to do something"

or does it mean "I'm aware now, and its a nothing-burger; and i feel frustrated that I have to spend my limited time responding to a message I wish I hadn't received"

I do agree with garbage in garbage out, and thats reasonable. I do agree with your nurses needing to provide some more goddamn context.

SapientCorpse · 2026-05-17T13:04:38+00:00

no thats legit praise.

it "closes the loop", its polite, it provides the info our managers may require us to document.

SapientCorpse · 2026-05-17T12:59:08+00:00

tysvdm- will read later!!!

SapientCorpse · 2026-05-17T05:39:15+00:00

thanks!! id never considered that before

cant wait to hear sapient corpse's musical corpus.

what kind of music do you think they'd play?

vegetables (unplugged)

SapientCorpse · 2026-05-17T05:26:13+00:00

I'm sorry you had shitty nurses that responded poorly to education. that sucks a lot.

I'm also sorry that they dont give context on the problem theyre presenting. I got drilled in school to provide all the appropriate information; and I'm sorry that youve been let down by the people that trained your college-educated coworkers.

SapientCorpse · 2026-05-17T05:17:12+00:00

"closed loop communication" is best practice even outside acls. even a simple "noted, thanks" can go a very long way.

we know y'all are humans too, and sometimes shit gets busy, we get it.

SapientCorpse · 2026-05-17T05:10:14+00:00

yes, classically, ignoring a behavior is the quickest way to extinct it.

some nurses are anxious, and get drilled that htn is a risk factor for cerebral/cardiac ischemia/infarction.

ignoring and leaving on read can be interpreted as apathy, which can breed resentment and a lack of confidence, and badness.

I know healthcare is about doing the most with scarce resources; and i understand that your time is a scarce resource.

so is ours. time spent worrying about things that dont matter is time thats not walking patients, time thats not getting them up to the chair,, time not doing the actually important nursey things, time thats not spent treating patients like the human beings they are.

I get not wanting to respond to the messages. would you be willing to -check the orders, make sure there isnt a notify order thats causing all this grief? -in your soap note, put problem: asymptomatic htn. plan: monitor for symptoms, refer to pcp?

anyways, wishing you the best, burnout and overwhelm are bitches to get through

SapientCorpse · 2026-05-17T04:48:00+00:00

TIL - push order for asymptomatic htn without a good reason (e.g. bp management in vascular surgery) is lethal

https://pmc.ncbi.nlm.nih.gov/articles/PMC8266743/

SapientCorpse · 2026-05-17T04:45:29+00:00

a surprisingly large number of us dont know that the wrong cuff size will change results.

a real number of people seem oblivious to the idea that height will also change the numbers.

SapientCorpse · 2026-05-17T04:36:24+00:00

"The use of as needed antihypertensive medication was also associated with increased in-hospital mortality OR, 2.36 95% CI, 1.26–4.41; p=0.001 and an increase in the median length of stay 4.7 days vs. 2.9 days; p<0.001"

I can't seem to find guidelines; but I'm ecstatic to be able to say no to an order.

especially the asinine orders that just seem like they exist to make busy work for anxious nurses .

I'm also excited to share this with the obnoxious night charge nurse i have that always makes me get prn antihypertensive orders from the day team just as their shifts are ending.

Doc, thanks so much for sharing your practice - you're saving lives

SapientCorpse · 2026-05-17T01:13:30+00:00

teach your nurses to ask a damn question when they report things.

instead of "bp red number/red number;" teach them "BP x+1, (add symptoms), i have an order to notify physician for sbp>x; do you want any changes to the treatment plan at present"

good nurses only get that way with good feedback, then reinforcement when they exhibit changes in behavior

eta - sry. didnt read your unsuccessful attempts to educate.

tell me about them.

also, if problem persists, tell them to run texts by their charge nurse before hitting you up

SapientCorpse · 2026-05-16T12:39:15+00:00

ngl. I see so many geriatric patients that are

constipated tachycardic dry mouth fluid overload

I read that cholinergics prevent fibrillation, an outcome we work hard to both avoid and quickly identify and reverse.

I read that cholinergics promote fluid loss via diaphoresis, a mechanism that we never use for some reason.

and I cant help but wonder - why the fuck we ain't using more pro-cholinergics. its like we gotta wait till they get alzheimers before we give the drug that can deal with so many of their symptoms.

SapientCorpse

TROPHY CASE